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NPI Code Detail

MEDICARE: MARISA PEPPER HIS

MEDICARE: MARISA PEPPER HIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1237700000XHearing Instrument Specialist3502013281MI

General Provider Information

NPI Number : 1528802204
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISA PEPPER HIS
Provider Business Mailing Address
First Line : 4095 CHICAGO DR SW
Second Line :
City : GRANDVILLE
State : MI
Zip : 49418-1296
Country : US
Telephone Number : 616-261-0417
Fax Number : 616-261-1459
Provider Business Practice Location Address
First Line : 4095 CHICAGO DR SW
Second Line :
City : GRANDVILLE
State : MI
Zip : 49418-1296
Country : US
Telephone Number : 616-261-0417
Fax Number : 616-261-1459
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2024
Last Update Date : 06/19/2024

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Directions to “ MARISA PEPPER HIS” Practice Location

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